EFFECTIVENESS OF LUMBAR TRACTION IN PRONE POSITION

AMONG INDIVIDUALS WITH HERNIATED NUCLEUS PULPOSUS:

AN EXPERIMENTAL STUDY

A Thesis Presented to the

Faculty of the College of Physical Therapy
Lyceum of the Philippines University Batangas

In Partial Fulfillment Of the Requirements

For the Degree of
Bachelor of Science in Physical Therapy

By:
Nazareno, Benjamin III L.
Luna, Queenie
 APPROVAL SHEET

In partial fulfilment of the requirements for the Degree of Bachelor of Science in Physical

Therapy. This thesis entitled “Effectiveness of Lumbar Traction in Prone Position Among

Individuals with Herniated Nucleus Pulposus: An Experimental Study” presented by:

Benjamin L. Nazareno III and Queenie Luna, is hereby recommended for oral examination.

____________________________________
Maria Simplicia E. Flores, PTRP, MSCPD
Adviser

Defended in oral examination before a duly constituted panel with a grade of

__________.

______________________________
Dr. Anacleta P. Valdez, MHA, FPSP
Chairman

___________________________ _______________________________
Oliver Shane R. Dumaoal, RMT Maria Simplicia E. Flores, PTRP,
MSCPD
Member Member

Accepted in partial fulfilment for the Degree of Bachelor of Science in Physical in Therapy.

_____________________________________
Dr. Anacleta P. Valdez, MHA, FPSP
Dean, College of Physical Therapy
 EFFECTIVENESS OF LUMBAR TRACTION IN PRONE POSITION
AMONG INDIVIDUALS WITH HERNIATED NUCLEUS PULPOSUS:
AN EXPERIMENTAL STUDY

Benjamin L. Nazareno III1* and Queenie Luna1

College of Allied Medical Profession, Lyceum of the Philippines University
Capitol Site, Batangas City, Philippines

1 Student Researcher
*Correspondence: Email: ben_third89@yahoo.com

ABSTRACT:

The spinal disc is a soft cushion that sits between each vertabrae of the spine, and
becomes more rigid with age. As a person ages, the disc gradually loses its elasticity and is more
vulnerable to injury. As the spinal disc becomes less elastic, it can rupture. When the disc
ruptures, a portion of the spinal disc pushes outside its normal boundary -this is called a
herniated disc.

Traction is commonly used for treatment of low back pain with nerve root involvement.
Spinal Traction is constant or intermittent pulling force applied to the spine to gradually stretch
it. It stretches muscles and ligaments and increases the space between the vertebrae.

The objective of this study is to evaluate the effects of using lumbar traction in prone
position to patients with herniated nucleus pulposus with symptoms of low back pain, utilizing a
experimental type of study. The participants of the study will be 20 patients with complaint of
low back pain, with diagnosis of herniated nucleus pulposus, from 2 hospitals: Mary Mediatrix
Medical Center, Lipa City, Batangas, and Philippine Orthopaedic Center Center, Quezon City,
Batangas. Consent from participants will be taken. The data gathering instrument is a numerical
pain scale (1-10), and the Modified Oswestry Low Back Pain Disability Questionnaire.
Participants’ data will be retrieved, tallied, tabulated and analyzed. Effects will be measured in
terms of pain scale, persistency of symptoms and effects on ROM (Range of Motion), MMT
(Manual Muscle Testing), and ADL (Activities of Daily Living).

Keywords: herniated nucleus pulposus, lumbar traction, prone position, pain scale, range of
motion, manual muscle testing, activities of daily living
Introduction:

Everyone could have low back pain at one time or another. This pain can vary from mild
to severe. It can be short-lived or long-lasting. Whether it's dull and annoying or screaming for
attention. Occupations such as nursing, construction and factory work place significant demands
on the back. Even routine office work can worsen back pain if the person falls into risky habits.

Work related low back pain is a common disabling condition worldwide, and counts as
the major cause of work absenteeism and insurance claim. Depending on the severity of pain and
its cause, the person may require medical help, such as physical therapy or even surgery.

Most common cause of low back pain is disc bulging, A bulging disc occurs when the
disc shifts out of its normal radius due to flexion movements, hence extension exercises are
recommended.1
The bones (vertebrae) that form the spine in the back are cushioned by small, spongy
discs. When these discs are healthy, they act as shock absorbers for the spine and keep the spine
flexible. But when a disc is damaged, it may bulge or break open. This is called a herniated disc,
or may also be called a slipped or bulged disc.

When a herniated disc presses on nerve roots, it can cause pain, numbness, and weakness
in the area of the body where the nerve travels. A herniated disc in the lower back can cause pain
and numbness in the buttock and down the leg. This is called sciatica, the most common
symptom of a herniated disc in the low back.

Many physical therapists use lumbar traction in conjunction with other treatments to
relieve lower back pain, especially sciatica. Prone position is used when excessive flexion of the
lumbar spine causes pain or increases peripheral symptoms.

A recent study done by Beattle P. et al (2008), showed that prone traction showed
significant improvements in pain intensity and RMDQ scores in both short- and long-term
follow-up of 296 subjects with low back pain and evidence of a degenerative and/or herniated
intervertebral disk at 1 or more levels of the lumbar spine2. Naguszweski WK et. al (2001) also
concluded that there were reductions of low back pain and leg pain in individuals diagnosed with
herniated disc that had treatment with traction3. Another study done by Gose EE et. al. (1998) in
patients that undergo Vertebral axial decompression therapy (VAX D) for pain associated with
herniated or degenerated discs or facet syndrome showed that there were improvements in
mobility and activities of daily living correlated strongly with pain reduction4. (VAX-D treatment
is a product designed to relieve pressure by applying tension on the structures that may be
causing back pain generally associated with bulging or herniated discs and degenerative disc
disease5. Position used in the VAX-D is prone.)

However, in a study by Borman P et al (2003), no specific effect of traction was observed

in their study group (those receiving standard physical therapy with lumbar traction). Beurskens
AJ et al (1997)’s randomized control trial also does not show effectiveness of motorized
continuous traction to low back pain patients.
Although traction is widely used, in conjunction with other treatment, there is still lack of
evidence that proves its efficacy, especially those using prone position. In this study, the
researchers will observe if prone position had better effects in reducing low back pain among
patients suffering from herniated nucleus pulposus compared to traction in supine position.

METHOD:

Design:

The researchers intended to conduct a research on “Effectiveness of Lumbar Traction in

Prone Position among Individuals with Herniated Nucleus Pulposus: An Experimental Study”.
Experimental design was used in evaluating the effects of lumbar traction in prone position to
patients with herniated nucleus pulposus with complaint of low back pain. The study determined
if there is a significant improvement in terms of pain scale, lessening the persistency of
symptoms, and effects to ROM, MMT, activities of daily living.

Participants: Inclusion Criteria

Twenty participants were purposively selected from 2 hospitals: Mary Mediatrix Medical
Center, Lipa City, Batangas, and Philippine Orthopaedic Center, Quezon City, Batangas. (No
specific number from each hospital, as long as 20 total eligible participants were met). The
subjects were divided into 2 groups: group A (experimental group) having lumbar traction in
prone position, group B (control group) in supine position. The patients included in the study
should have met the following criteria:

1. To be eligible for inclusion, subjects should be diagnosed by their physician with

herniated nucleus pulposus, with complaint of low back pain, defined as pain in the area
between the 12th rib and buttock crease (with or without leg pain), with onset of 3-4
months, and then referred for a physical therapy.
2. Middle adults 35-60 years old of either gender (male or female)
3. Able to speak Tagalong or English
4. Can attend therapy for 3 times a week for 6 weeks

Subjects were excluded if they were diagnosed of the following spinal conditions: cauda
equina syndrome, cord compression, infection, fracture, neoplasm, inflammatory disease,
pregnancy, any form of headache, vertigo/dizziness, spinal surgery in the past 6 months. Written
consents will be obtained from all those who agreed to participate.

Data were compared between these two groups to show if there is a significant
improvement in terms of pain scale, persistency of symptoms and effects on ROM (Range of
Motion), MMT (Manual Muscle Testing), and ADL (Activities of Daily Living) to either of the
group.
Instrument:

The study adopted the following data gathering instruments: a numerical pain scale (1-
10), Modified Oswestry Low back pain disability Questionaire. Other instruments used were
Manual Muscle Testing Checklist (Hislop H., Montgomery J.),and Range of Motion Record
(Norkin C., White DJ) .

Procedures:

Prior to the conduct of study, selection process among the patients were conducted to
determine if they meet the inclusion criteria. Each subject undergoes the following assessment in
order to establish baseline data. Informed consents were given among the subjects. The
participants had therapies three times per week for 6 weeks, and were evaluated on a weekly
basis using the adapted questionnaire. Per session lasts 30 minutes.
Beattie PF, Nelson RM, Michener LA, Cammarata J, Donley J. Outcomes after a prone lumbar
traction protocol for patients with activity-limiting low back pain: a prospective, case series
study.

Naguszewski W, Naguszewski R, Gose E. Dermatomal somatosensory evoked potential

demonstration of nerve root decompression after VAX-D therapy. Neurol Res. 2001;23:706–714

Beurskens A, de Vet H, Koke A, et al. Efficacy of traction for nonspecific low back pain: 12-
week and 6-month results of a randomized clinical trial. Spine. 1997;22:2756–2762

Borman P, Keskin D, Bodur H. The efficacy of lumbar traction in the management of patients
with low back pain. Rheumatol Int. 2003;23:82–86

Gose E, Naguszewski W, Naguszewski R. Vertebral axial decompression therapy for pain

associated with herniated or degenerated discs or facet syndrome: an outcome study. Neurol Res.
1998;20:186–190